Title

Characteristics that affect a HIV infected individual's utilization of HIV medical care

Date of Award

2007

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Bonnie Harbaugh

Advisor Department

Nursing

Abstract

Despite the recognized benefits of HIV medical care to treat individuals infected with HIV and prevent further spread of the virus, over half of the 1.2 million HIV infected individuals in the US are "out of care" (HRSA/HAB 2002). Minimal research has explored characteristics of the HIV infected individual that may influence HIV medical care utilization. The literature insinuates a potential association between HIV infected individuals' HIV specific attitudes, perceived stigma and trust in the health care system and their utilization of HIV medical care. This study was designed to determine if there is a difference in the attitudes, levels of perceived stigma, degrees of trust in the health care system, perceived need (number and intensity of symptoms) and evaluated need (CD 4 count) for care between those who returned to use HIV medical care (U+) and those who did not return (U-). Subjects from one HIV Clinic in the southern US were recruited for the study. The Scale of Utilization of Medical Care-HIV (SUMCH) was used to measure these characteristics. Medical record abstraction determined HIV medical care utilization (U+ or U-). A convenience sample of 137 subjects who were "new" to HIV care or returning to HIV medical (no HIV medical care > 24 months) were enrolled in the study from June 2006 through May 2007. The sample consisted of 45% females, 88% African Americans, 74% heterosexual, with 75% having reported no previous HIV medical care. Of those enrolled, 27% of the sample did not return to utilize HIV medical care. Though 38 subjects reported direct damage to their lives and/or property due to Hurricane Katrina, these effects did not significantly impact HIV medical care utilization. Comparisons of means showed statistically significant difference in HIV attitudes and perceived stigma regarding HIV infection between the two groups (U+, (p < 0.10). Logistic regression analysis revealed that the HIV infected individual's level of perceived stigma, age, a history of Intravenous drug use (IVU), length of HIV diagnosis and length to time of return to clinic predicted HIV medical care utilization (Wald test p < 0.001).